Method for Bone Reattachment

ABSTRACT

A method for trochanteric reattachment can include positioning a femoral prosthesis relative to a proximal portion of a femur. A first portion of a self-locking adjustable flexible member construct can be coupled to a first attachment region of the prosthesis, and a second portion of the self-locking adjustable flexible member construct can be coupled to a second attachment region of the femoral prosthesis, where the second portion can be opposite the first portion. A trochanter can be positioned relative to the femur and a trochanteric engaging region of the prosthesis, and the self-locking adjustable flexible member construct can be positioned around an outer surface of the trochanter. Free ends of the self-locking adjustable flexible member construct can be tensioned to draw the trochanter into secure engagement with the prosthesis and the femur via the self-locking adjustable flexible member construct in an absence of a knot.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No. 13/111,564 filed on May 19, 2011, which is a continuation-in-part of U.S. patent application Ser. No. 12/938,902 filed on Nov. 3, 2010, which is a continuation-in-part of U.S. patent application Ser. No. 12/915,962 filed on Oct. 29, 2010, now U.S. Pat. No. 8,561,647 issued on Oct. 22, 2013, which is a continuation-in-part of U.S. patent application Ser. No. 12/719,337 filed on Mar. 8, 2010, which is a continuation-in-part of U.S. patent application Ser. No. 12/489,168 filed on Jun. 22, 2009, now U.S. Pat. No. 8,361,113 issued on Jan. 29, 2013, which is a continuation-in-part of U.S. patent application Ser. No. 12/474,802 filed on May 29, 2009, now U.S. Pat. No. 8,088,130 issued on Jan. 3, 2012, which is a continuation-in-part of (a) U.S. patent application Ser. No. 12/196,405 filed on Aug. 22, 2008, now U.S. Pat. No. 8,128,658 issued on Mar. 6, 2012; (b) U.S. patent application Ser. No. 12/196,407 filed on Aug. 22, 2008, now U.S. Pat. No. 8,137,382 issued on Mar. 20, 2012; (c) U.S. patent application Ser. No. 12/196,410 filed on Aug. 22, 2008, now U.S. Pat. No. 8,118,836 issued on Feb. 21, 2012; and (d) U.S. patent application Ser. No. 11/541,506 filed on Sep. 29, 2006, which is now U.S. Pat. No. 7,601,165 issued on Oct. 13, 2009.

This application is a continuation-in-part of U.S. patent application Ser. No. 13/645,964 filed on Oct. 5, 2012, which is a continuation-in-part of U.S. patent application Ser. No. 12/570,854 filed on Sep. 30, 2009, now U.S. Pat. No. 8,303,604 issued on Nov. 6, 2012, which is a continuation-in-part of U.S. patent application Ser. No. 12/014,399 filed on Jan. 15, 2008, now U.S. Pat. No. 7,909,851 issued on Mar. 22, 2011, which is a continuation-in-part of U.S. patent application Ser. No. 11/347,661 filed on Feb. 3, 2006, which is now U.S. Pat. No. 7,749,250 issued on Jul. 6, 2010.

This application is a continuation-in-part of U.S. patent application Ser. No. 12/702,067 filed on Feb. 8, 2010, which is a continuation of U.S. patent application Ser. No. 11/541,505 filed on Sep. 29, 2006 and is now U.S. Pat. No. 7,658,751 issued on Feb. 9, 2010.

This application is a continuation-in-part of U.S. patent application Ser. No. 13/098,927 filed on May 2, 2011, which is a continuation-in-part of U.S. patent application Ser. No. 12/196,398 filed Aug. 22, 2008, now U.S. Pat. No. 7,959,650 issued on Jun. 14, 2011, which is a continuation-in-part of U.S. patent application Ser. No. 11/784,821 filed Apr. 10, 2007.

The disclosures of all of the above applications are incorporated by reference herein.

FIELD

The present disclosure relates generally to a method for securing a fractured or resected bone, and more particularly to methods for trochanteric reattachment.

BACKGROUND

The statements in this section merely provide background information related to the present disclosure and may not constitute prior art.

After trauma or surgical intervention, there may be a need to fix bone fragments or portions together to immobilize the fragments and permit healing. Compressive force can be applied to the bone fragments by encircling the bone fragments or bridging the fragments together across a broken, sectioned, resected or otherwise compromised portion of the bone. The compressive forces should be applied such that upon ingrowth of new bone, the fragments will heal together and restore strength to the site of trauma or surgical intervention.

For example, in many reconstructive procedures of the hip, the greater trochanter is often resected from the proximal femur and then retracted to permit the physician to approach the joint. After the femoral head is replaced with a prosthetic femoral component, the greater trochanter can be relocated and fastened in place. Existing methods for reattachment of the greater trochanter include the use of U-bolts, bolts, clamps, plates and screws.

While these methods work for their intended purpose, there remains a need for improved apparatus and methods to apply compressive force to a bone, such as the greater trochanter, across a fracture or other resected area to maintain alignment and assist healing. Further, there is a need for apparatus and methods that are easy to use intraoperatively to accommodate various bone sizes or shapes, or locations of bone fractures or resections.

SUMMARY

This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features.

In one form, a method for trochanteric reattachment is provided in accordance with various aspects of the present teachings. The method can include positioning a femoral prosthesis relative to a proximal portion of a femur. A first portion of a self-locking adjustable flexible member construct can be coupled to a first attachment region of the femoral prosthesis, and a second portion of the self-locking adjustable flexible member construct can be coupled to a second attachment region of the femoral prosthesis, where the second portion can be opposite the first portion. A trochanter can be positioned relative to the femur and a trochanteric engaging region of the femoral prosthesis, and the self-locking adjustable flexible member construct can be positioned around an outer surface of the greater trochanter. Free ends of the self-locking adjustable flexible member construct can be tensioned to draw the trochanter into secure engagement with the femoral prosthesis and the femur via the self-locking adjustable flexible member construct in an absence of a knot.

In another form, a method for trochanteric reattachment is provided in accordance with various aspects of the present teachings. The method can include positioning a femoral prosthesis relative to a proximal portion of a femur. First and second bores can be formed spaced apart from each other and through a greater trochanter that has been at least partially separated from the femur. A first portion of a self-locking adjustable flexible member construct can be passed through the first bore, and the first portion can be coupled to a first attachment region of the femoral prosthesis. A second portion of the self-locking flexible member construct can be passed through the second bore, and the second portion can be coupled to a second attachment region of the femoral prosthesis opposite of the first attachment region. The self-locking adjustable flexible member construct can be positioned around an outer surface of the greater trochanter. Free ends of the self-locking adjustable flexible member construct can be tensioned to draw the greater trochanter into secure engagement with the femoral prosthesis and the femur via the self-locking adjustable flexible member construct in an absence of a knot.

In yet another form, a method for trochanteric reattachment is provided in accordance with various aspects of the present teachings. The method can include positioning a femoral prosthesis relative to a proximal portion of a femur, where the prosthesis can include first and second attachment regions each having a plurality of attachment members spaced apart from each other and arranged at increasing distances from a proximal end of the prosthesis toward a distal end. The first and second attachment regions can be on opposite sides of the femoral prosthesis. A first portion of a first self-locking adjustable flexible member construct can be coupled to a first attachment member of the first attachment region, and a second portion of the first self-locking adjustable flexible member construct can be coupled to a second attachment member of the second attachment region. A first portion of a second self-locking adjustable flexible member construct can be coupled to a third attachment member of the first attachment region, and a second portion of the second self-locking adjustable flexible member construct can be coupled to a fourth attachment member of the second attachment region. The first and second self-locking adjustable flexible member constructs can be positioned around an outer surface of the greater trochanter such that the first and second self-locking adjustable flexible member constructs overlap each other. Free ends of the first and second self-locking adjustable flexible member constructs can be tensioned to draw the greater trochanter into secure engagement with the femoral prosthesis and the femur via the self-locking adjustable flexible member construct in an absence of a knot.

Further areas of applicability will become apparent from the description provided herein. The description and specific examples in this summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.

DRAWINGS

The present teachings will become more fully understood from the detailed description, the appended claims and the following drawings. The drawings are for illustrative purposes only of selected embodiments and not all possible limitations, and are not intended to limit the scope of the present disclosure.

FIG. 1 is a partial view of the bones of an exemplary hip joint, where a proximal portion of the femur and a portion of the surrounding soft tissue have been resected and replaced with an exemplary femoral hip prosthesis in accordance with the teachings of the present disclosure;

FIG. 2 is a partial view of the exemplary femoral prosthesis of FIG. 1 having an attachment region in accordance with the teachings of the present disclosure;

FIGS. 3-6 are views of exemplary adjustable flexible member constructs having optional fasteners coupled thereto in accordance with the teachings of the present disclosure; and

FIGS. 7-16 are various views depicting exemplary techniques for trochanteric reattachment using the various adjustable flexible member constructs of FIGS. 3-6 in accordance with the teachings of the present disclosure.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is not intended to limit the present disclosure, its application, or uses. It should be understood that throughout the drawings, corresponding reference numerals indicate like or corresponding parts and features. Although the following discussion is related generally to reattachment of the greater trochanter of a femur, it should be appreciated that the method and apparatus discussed herein can be applied to other bones and/or areas of the anatomy including, for example, the greater trochanter of a humerus of a shoulder joint.

Exemplary embodiments are provided so that this disclosure will be thorough, and will fully convey the scope to those who are skilled in the art. Numerous specific details are set forth such as examples of specific components, devices, systems and/or methods, to provide a thorough understanding of exemplary embodiments of the present disclosure. It will be apparent to those skilled in the art that specific details need not be employed, that exemplary embodiments may be embodied in many different forms and that neither should be construed to limit the scope of the disclosure. In some exemplary embodiments, well-known processes, well-known device structures, and well-known technologies are not described in detail.

With initial reference to FIGS. 1 and 2, an exemplary proximal femoral prosthesis 10 is shown for use in replacing a portion of the proximal femur 14 in a hip joint 18. As will be discussed in greater detail below, femoral prosthesis 10 can be used for reattachment of greater trochanter 22 that has been fractured, separated, and/or resected during a hip reconstruction procedure.

In the exemplary configuration illustrated, femoral prosthesis 10 can include a proximal body 26 having a trochanteric engaging region 30 and a trochanteric attachment region 34. A tapered neck portion 38 can extend from the proximal body 26 and can be configured to mate with a femoral head 42. After implantation, femoral head 42 can be configured to mate with an implanted acetabular prosthesis 46, as shown in FIG. 1. A distal end 50 of the proximal body 26 can include a female bore 54 configured to mate with a corresponding proximal extension 58 of a distal stem 62. In one exemplary configuration, the proximal body 26 can be interconnected to the distal stem 62 via a Morse taper connection 66.

The femoral prosthesis 10 can be provided in the modular configuration discussed above where various sizes of the proximal body 26 can be interconnected to various sizes of distal stems 62 based on a particular size and/or configuration of a patient's anatomy. It should be appreciated, however, that femoral prosthesis 10 can be also be provided in a unitary configuration.

The trochanteric attachment region 34 can include a flanged region 74 on first and second sides 78, 82 of a proximal end 86 of the proximal body 26, as shown in FIGS. 1 and 2 with reference to FIG. 8. The flanged regions 74 can include a plurality of discrete attachment areas, such as apertures 90, configured to receive adjustable flexible member constructs for securing the separated greater trochanter 22, as will be discussed in greater detail below. It should be appreciated that while four apertures 90 are shown in the flanged regions 74, more or less apertures can be provided in proximal body 26 as may be desired for different applications and/or anatomical sizes. In this regard, and as will be discussed below, flanged regions 74 can also be provided with alternative attachment configurations, such as projections or tabs 104 (FIGS. 14 and 15) that can be provided in addition to or in lieu of apertures 90.

The proximal body 26 can be provided with a through hole 106 (FIG. 2) and a roughened or porous metal coating 108 to enhance biologic fixation and boney ingrowth, such as a layer of Regenerex® porous titanium construct or a layer of PPS® Porous Plasma Spray, available from Biomet Manufacturing Corp., having a place of business in Warsaw, Ind. In one exemplary configuration, components of the femoral prosthesis 10 can include those associated with the Mallory-Head Modular Calcar Revision System™ also available from Biomet Manufacturing Corp.

With additional reference to FIGS. 3-6, various adjustable flexible member constructs 110 are shown that can be associated with proximal body 26 for use in reattachment of greater trochanter 22. With particular reference to FIG. 3, a preformed adjustable self-locking flexible member construct 110A is provided according to the present teachings and can include a braided flexible member or suture 114 having a first end 118 and a second end 122. Flexible member 114 can include a body 126 that defines a longitudinal passage portion 130 therein between first and second ends 118, 122. The passage portion 130 can define a pair of apertures 134, 138 at opposed ends thereof.

To form construct 110A, the first end 118 can be passed through aperture 134 and passage portion 130 and out aperture 138 such that a portion 146 of flexible member 114 following first end 118 extends through passage portion 130. In a similar manner, second end 122 can be passed through aperture 138 and passage portion 130 and out aperture 134 such that a portion 150 of flexible member 114 following second end 122 also extends through passage portion 130. This configuration can form two loops 154 and 154′, as shown in FIG. 3. It should be appreciated that while passage portion 130 is shown having two apertures or openings 134, 138, passage portion 130 can have additional openings and/or can include additional passage portions.

Adjustable flexible member construct 110A can include a pair of collapsible tubes or flexible anchors 160, as also shown in FIG. 3. One flexible anchor 160 can be coupled to loop 154 and the other flexible anchor 160 can be coupled to loop 154′, as will be discussed below in greater detail. Flexible anchor 160 can be an elongate member having a sleeve or tubular configuration with first and second ends 168, 172 and an internal passage 176 extending therebetween, as shown in FIG. 3A. The flexible anchor 160 can be made of resorbable or non-resorbable materials, including braided suture, sponges and sponge-like materials in solid form, perforated materials, woven/braided from biocompatible materials or fibers, such as, for example, polymer, polyester, polyethylene, cotton, silk, or other natural or synthetic materials.

The flexible anchor 160 can have any properties that allow the flexible anchor 160 to change shape. In this regard, the flexible anchor 160 can be, for example, compliant, flexible, foldable, squashable, squeezable, deformable, limp, flaccid, elastic, low-modulus, soft, spongy or perforated, or have any other characteristic property that allows it to change shape. In some aspects, the flexible anchor 160 can be coated with biological or biocompatible coatings, and also can be soaked in platelets and other biologics, which can be easily absorbed by the flexible anchor 160. In one exemplary configuration, the flexible anchor 160 can be formed from a strand of No. 5 braided polyester suture. In other words, multiple fibers can be braided together to form a hollow braided flexible member having an internal passage.

As shown for example in FIG. 3A, flexible member 114 can be passed through a first opening 174 in a wall of the flexible anchor 160, guided into and along the internal passage 176, and passed out of the internal passage 176 through a second opening 178 in a wall of the flexible anchor 160 to associate flexible anchor 160 with loops 154, 154′. The openings 174, 178 can be positioned intermediately between the first and second ends 168, 172 of the flexible anchor 160 at a distance of, for example, one-quarter length from ends 168, 172. It will be appreciated that the openings 174, 178 can be apertures or voids in the woven fabric of the flexible anchor 160, such that the openings 174, 178 do not disrupt or break the weave of the flexible anchor 160 when made of braided or woven material. Further, portions of the flexible anchor 160 between the first and second ends 168, 172 and the corresponding first and second openings 174, 178, can define anchoring leg or tail portions 190 that can provide additional resistance for securing the flexible anchor 160 relative to a bone, fastener or implant, as will be discussed in greater detail herein. In one exemplary configuration, flexible member 114 can pass only through openings 174, 178 and a portion of the internal passage 176 extending therebetween to form a loop that does not extend through tail portions 190.

The pulling or tensioning of ends 118, 122 of flexible member construct 110A can cause reciprocal movement of portions 146, 150 relative to passage portion 130, and the loops 154, 154′ can be reduced to a desired size and/or placed in a desired tension. Tension in loops 154, 154′ can cause the body 126 defining the passage portion 130 to be placed in tension and therefore cause passage portion 130 to constrict about portions 146, 150 passed therethrough. This constriction reduces the diameter of passage portion 130, thus forming a mechanical interface between the exterior surfaces of portions 146, 150 and an interior surface of passage portion 130. This constriction results in static friction between the interior and exterior surfaces at the mechanical interface, causing the adjustable flexible member construct 110A to “automatically” lock in a reduced size or diameter configuration in which tension is maintained without use of a knot.

With reference to FIGS. 4A and 4B and continuing reference to FIGS. 3A and 3B, an alternative preformed adjustable self-locking flexible member construct 110B is shown. Construct 110B can be preformed to include a double loop configuration having two loops 204, 204′ that each traverse a path from one end of passage portion 130 to the other end thereof, instead of each loop being disposed at respective opposite ends of passage portion 130 as in construct 110A. Flexible member construct 110B can be formed by passing the first end 118 of the flexible member through aperture 138, through passage portion 130 and out aperture 134. The second end 122 can be passed through aperture 134, through the passage portion 130 and out the aperture 138. In various aspects, the first and second apertures 134, 138 can be formed during the braiding process as loose portions between pairs of fibers defining the flexible member 114, as discussed above.

Passing ends 118, 122 through the apertures 134, 138 can form the loops 204, 204′. The loops 204, 204′ can define mount or summit portions 208, 208′ of the adjustable flexible member construct 110B and can be disposed generally opposite from the passage portion 130. Adjustable flexible member construct 110B can also include a pair of flexible anchors 160, as shown in FIGS. 4A and 4B. With reference to FIG. 4A, one flexible anchor 160 can be coupled to the summit portions 208, 208′ of loops 204, 204′ such that both loops 204, 204′ extend through the respective flexible anchor 160 in a similar manner as discussed above with respect to flexible member construct 110A. The other flexible anchor 160 can be coupled to passage portion 130 such that passage portion 130 extends through the flexible anchor 160 in a similar manner as discussed above. With reference to FIG. 4B, adjustable flexible member construct 110B can alternatively include flexible anchors 160 coupled to loops 204, 204′ at opposite sides 214, 218 of passage portion 130.

The longitudinal and parallel placement of the first and second ends 118 and 122 of the flexible member 114 within the passage portion 130 resists the reverse relative movement of the first and second portions 146, 150 of the flexible member construct 110B once it is tightened. The tensioning of the ends 118 and 122 can cause reciprocal movement of the portions 146, 150 relative to passage portion 130. Upon applying tension to the first and second ends 118 and 122, the loops 204, 204′ can be reduced to a desired size or placed in a desired tension. Tension in the loops 204, 204′ can cause the body 126 of the flexible member 114 defining the passage portion 130 to be placed in tension and therefore cause passage portion 130 to constrict about the portions 146, 150 similarly to the constriction discussed above with respect to construct 110A. This constriction can cause the adjustable flexible member construct 110B to “automatically” lock in a reduced size or smaller diameter configuration without the use of a knot.

Turning now to FIG. 5, an exemplary adjustable self-locking flexible member construct 110C is provided having only one loop 204. Adjustable flexible member construct 110C can be preformed in a similar manner as construct 110B, but with only one loop. Flexible member construct 110C can include a pair of flexible anchors 160 coupled thereto in a similar manner as discussed above with reference to FIGS. 4A and 4B.

With additional reference to FIG. 6, an adjustable flexible member construct 110D is provided according to various aspects of the present teachings. The adjustable flexible member construct 110D can be fashioned from flexible member 114 made of any biocompatible material including, but not limited to, non-resorbable polymers, such as polyethylene or polyester, resorbable polymers, and various combinations thereof. In various aspects, the adjustable flexible member construct 110D can include a hollow material or core to allow for appropriate tensioning, as will be discussed herein. In various aspects, the flexible member 114 can be hollow or a braided or a multiple-filament braided suture structure having a hollow core. In various aspects, the suture can be resorbable.

The adjustable flexible member construct 110D can include a first end 220, a first formed passage portion 224, a second end 228, a second formed passage portion 232, and a fixed length loop portion 236 connecting the first and second passage portions 224, 232, as shown in FIG. 6. In one exemplary aspect, flexible member construct 110D can include an elongated body 240 having an exterior surface and an interior surface defining an elongated passage between the first and second ends 220, 228. The body 240 can define the first and second passage portions 224, 232 and the fixed length portion 236 therebetween. Passage portions 224, 232 can each include first apertures 244, 248 positioned proximate one end 252 thereof, and second apertures 256, 260 positioned proximate a second opposite end 264 thereof. The passage portions 224, 232 can be formed to have a larger width or diameter than remaining portions of flexible member 114, as shown for example in FIG. 6. Alternatively, the passage portions 224, 232 can be formed initially to have the same width or diameter as the remaining portions of flexible member 114, later expanding in diameter during the construction process. In various aspects, the first and second apertures 244, 248, 256, 260 can be formed during a braiding process of flexible member 114 as loose portions between pairs of fibers defining flexible member 114, or can be formed during the construction process. Alternatively, the first and second ends 220, 228 can be pushed between individual fibers of the braided flexible member 114.

To form the adjustable flexible member construct 110D, first end 220 can be passed through second passage portion 232 via first and second apertures 248, 260, as generally shown in FIG. 6. In a similar manner, second end 228 can be passed through the first passage portion 224 via the first and second apertures 244, 256, as also shown in FIG. 6. Subsequently, first end 220 can be passed through the first passage portion 224 via second and first apertures 256 and 244, respectively. First end 220 can follow a path that is opposite in direction to a path followed by a portion 272 of the flexible member 114 that has already passed through first passage portion 224 while following second end 228 through first and second apertures 244 and 256. Similarly, second end 228 can be passed through the second passage portion 232 via second and first apertures 260 and 248, respectively. Second end 228 can follow a path that is opposite in direction to a path followed by a portion 276 of the flexible member 114 that has already passed through second passage portion 232 while following first end 220 through first and second apertures 248 and 260. This results in portions 280, 284 of flexible member 114 being positioned parallel or substantially parallel to portions 272, 276 in passage portions 224, 232. Passing the first and second ends 220, 228 though passage portions 224, 232 as discussed above forms adjustable loops 288, 292, as shown in FIG. 6. The first and second ends can be passed through the same apertures in each passage portion 224, 232 or, alternatively, through separate apertures in each passage portion 224, 232.

The adjustable flexible member construct 110D can provide a double adjustable loop configuration via adjustable loops 288, 292 while also providing portion 236, which can have a fixed length between the passage portions 224, 232. This configuration can be used, for example, to couple a flexible anchor 160 to loops 288, 292 and couple fixed length portion 236 to flexible anchor 160 and/or another device.

Flexible member constructs 110A-110D also can be provided with an antibiotic and/or platelet concentrate coating to resist bacterial adhesion and/or promote healing. In this regard, flexible member constructs 110A-110D, can be pre-configured with such a coating or the coating can be applied intraoperatively. Further, the surgeon can also apply the platelet coating to the fractured or resected area of the greater trochanter 22 during the trochanteric reattachment procedure.

With additional reference to FIGS. 7-16, the use of flexible member constructs 110A-110D in various exemplary trochanteric reattachment configurations and procedures will now be discussed. With initial reference to FIG. 7, proximal femoral prosthesis 10 is shown implanted in femur 14. A proximal portion of femur 14 has been resected and the greater trochanter 22 has been separated, as discussed above and shown in FIG. 7 with reference to exemplary line 300. The greater trochanter 22 has been separated along exemplary line 300, during a hip reconstruction procedure for example, and is shown repositioned or relocated against femur 14 along line 300 and against the trochanteric engaging region 30 of proximal body 26. Flexible member constructs 110A-110D individually, or in various combinations with each other and/or additional fixation devices, can be used to compress and secure the greater trochanter 22 to femur 14 and proximal body 26 to assist healing, as will be discussed below. While the following discussion continues with reference to greater trochanter 22 of femur 14, it should be appreciated that the techniques can also be applied to the greater trochanter of the humerus in configurations similar to those shown in FIGS. 7-16.

With particular reference to FIGS. 7 and 8, a pair of adjustable flexible member constructs 110A are shown coupled to proximal body 26 to compress and secure greater trochanter 22 to femur 14 and proximal body 26. In the exemplary configuration illustrated, the flexible anchor 160 coupled to loop 154 of construct 110A can be positioned through aperture 90 of flanged region 74 on first side 78 from a lateral side 310 to a medial side 314. Flexible member construct 110A can then be wrapped around an outer surface 318 of greater trochanter 22 and flexible anchor 160 coupled to loop 154′ can be positioned though aperture 90 on second side 82, as shown in FIG. 7 with reference to FIG. 8. As also shown, more than one flexible member construct 110A can be used, as may be desired depending on particular aspects of the anatomy and/or procedure being performed.

In this configuration, flexible member constructs 110A extend around outer surface 318 without extending through greater trochanter 22 to reach apertures 90. In this regard, depending on a width 322 of the greater trochanter 22 relative to a width 326 between a corresponding pair of apertures 90, the flexible anchors 160 may need to be positioned through apertures 90 before the greater trochanter 22 is relocated against trochanteric engaging region 30 because the greater trochanter 22 can cover access to apertures 90. For example, and with particular reference to FIG. 8, greater trochanter 22 is shown as having a width 322 wider than the width 326 between apertures 90 such that greater trochanter 22 can cover apertures 90 upon being relocated against proximal femoral body 26.

The flexible member constructs 110A can be coupled to any of the apertures 90 in the flanged regions 74 in various patterns and configurations, as may be required depending on a patient's greater trochanter geometry, as will be discussed below. In addition, various other flexible member constructs 110B-110D can be used in addition to and/or in lieu of constructs 110A to secure the greater trochanter 22, as will also be discussed below.

With additional reference to FIG. 9, a bore 334 can be formed through the greater trochanter 22 in alignment with an aperture 90 selected to receive one of the adjustable flexible member constructs 110. In the exemplary configuration illustrated, construct 110A is shown extending through bore 334 and through aperture 90. Depending on the angle of approach chosen to align bore 334 with aperture 90, as well as the form of outer surface 318, bore 334 can extend through a portion or all of a thickness 338 of greater trochanter 22. For example, bore 334 shown in FIG. 9 extends through a portion of the thickness 338 of greater trochanter 22. In one exemplary aspect, bores 334 can be used when the greater trochanter 22 remains partially attached to the femur 14 and access to apertures 90 can be limited. While FIG. 9 illustrates use of one flexible member construct 110A, it should be appreciated that multiple flexible member constructs 110A-110D can be used with or without bores 334 having varying lengths relative to thickness 338 of greater trochanter 22.

In the configurations illustrated in FIGS. 7-9, the free ends 118, 122 of each flexible member construct 110A coupled to proximal body 26 can then be tensioned to reduce a size of loops 154, 154′ and compress the greater trochanter 22 into a secured engagement with femur 14 and proximal body 26. The tail portions 190 of anchors 160 can engage a surface 346 of the flanged regions 74 adjacent the apertures to anchor the loops 154, 154′ relative to the proximal body 26, as shown in FIGS. 7-9. In one exemplary configuration, tail portions 190 as well as the entire anchor 160, can bunch together, collapse, expand and/or change shape to a second shape, configuration or locking profile 350 to secure loops 154, 154′ to flanged regions 74. It should be appreciated that flexible anchors 160, upon being anchored to an appropriate surface, such as surface 346 associated with apertures 90, permit the associated flexible member loop to slide relative to the flexible anchor such that the loops can be reduced in size upon being tensioned. Flexible construct 110A can automatically lock under tension, as discussed above, after which a portion of ends 118, 122 can be trimmed and removed. This configuration can compress the greater trochanter 22 along line 300 with minimal modification to the greater trochanter 22, as compared to other procedures or techniques using a trochanter bolt extending through greater trochanter 22.

With additional reference to FIG. 10, another exemplary technique for securing the greater trochanter 22 is shown in accordance with the present teachings. In this exemplary configuration, a bore 334 can extend through a partial thickness of the greater trochanter 22 (FIG. 9) or through an entire thickness, as shown in FIG. 10. Bore 334 can be formed in greater trochanter 22 relative to the apertures 90 selected for use with one of the adjustable flexible constructs 110A-110D. In this regard, it should be appreciated that while bore 334 is shown in FIG. 10 relative to the first side 78 of proximal body 26, a corresponding bore 334 can formed in greater trochanter 22 relative to the corresponding aperture 90 on the second side 82 (FIG. 8) of proximal body 26. In one exemplary configuration, the pair of bores 334 and adjustable flexible member constructs shown in FIG. 10 relative to the first side 78 of proximal body 26 can be reproduced as a mirror image relative to the second side 82 of proximal body 26. As a result, the following discussion will continue with reference to the first side 78, but will be understood to apply to the second side 82 as well, unless otherwise indicated.

Once bores 334 are formed in greater trochanter 22 to align with the selected apertures 90, one of the adjustable flexible member constructs 110A-110D, such as construct 110A shown in FIG. 10, can be used to secure greater trochanter 22 to proximal body 26 via apertures 90. In the exemplary configuration illustrated, flexible anchor 160 coupled to loop 154 can be positioned through each bore 334 and corresponding aperture 90 in flanged region 74. Once flexible anchor 160 is positioned through aperture 90, the tail portions 190 can engage surface 346 adjacent aperture 90 to secure loop 154 relative to proximal body 26 in a similar manner as discussed above. Free end 122 of each construct 110A can also extend through apertures 90 while the opposite free end 118 as well as loop 154′ can extend from the greater trochanter 22 relative to an opening 354 of bore 334 opposite flanged region 74, as also shown in FIG. 10.

The free ends 118, 122 of flexible member construct 110A can be tensioned to reduce a size of the loops 154, 154′ in a manner similar to that discussed above. Tensioning the free ends 118, 122 and reducing a size of loops 154, 154′ can seat each flexible anchor 160 relative to the outer surface 318 and surface 346 of proximal body 26 and draw the greater trochanter 22 into secured engagement with proximal body 26 and femur 14, as shown in FIG. 10. It should be appreciated that while FIG. 10 illustrates use of flexible member construct 110A, any of flexible member constructs 110A-110D can be used alone or in various combinations with each other. In this regard, it should also be appreciated that different flexible member constructs could be used on the first and second sides 78, 82 of proximal body 26, as may be desired.

With additional reference to FIGS. 11 and 12, and reference back to FIG. 8, adjustable flexible member constructs 110B and 110D are shown coupled to proximal body 26 to compress and secure greater trochanter 22 to femur 14 and proximal body 26. With particular reference to FIG. 11, flexible member constructs 110B are shown coupled to apertures 90 and wrapping around outer surface 318 of greater trochanter 22 in a similar manner as discussed above with reference to FIG. 7 and flexible member construct 110A. In this illustrated configuration, free ends 118, 122 can extend about the first and second sides of proximal body 26 as the passage portion 130 and loops 204, 204′ of flexible member construct 110B can extend around or relative to outer surface 318 of greater trochanter 22.

In an alternative configuration where flexible anchors 160 are coupled to the passage portion 130 and summit portions 208, 208′, as shown in FIG. 4A, the passage portion 130 can be coupled to apertures 90, say on the first side 78, and the summit portions can then be coupled to apertures 90 on the second side 82. In this configuration, the free ends 118, 122 can extend from the respective apertures 90 relative to one side of the proximal body 26 instead of relative to both the first and second sides 78, 82. In either configuration, the free ends 118, 122 can be tensioned in the manner discussed above to draw greater trochanter 22 into tight engagement with proximal body 26 and femur 14 to secure greater trochanter 22 thereto and promote healing.

As can be seen in FIG. 12 with reference back to FIGS. 6 and 8, flexible member construct 110D is shown coupled to proximal body 26 and securing greater trochanter 22 thereto and to femur 14. In this configuration, one of the flexible anchors 160, such as flexible anchor 160 coupled to loops 288, 292 can be positioned through aperture 90 on first side 78 and the other flexible anchor 160 coupled to fixed portion 236 can be positioned through aperture 90 on second side 82. The free ends 220, 228 can extend about a side of proximal body 26, such as the first side 78 shown in FIG. 11, that includes the passage portions 224, 232 positioned relative thereto. The free ends 220, 228 can be tensioned to reduce a size of loops 288, 292 and draw greater trochanter 22 into compressed engagement with proximal body 26 and femur 14 to secure greater trochanter 22 relative thereto and promote healing. In a similar manner to the other configurations discussed above, more than one flexible member construct 110D can be used and secured relative to apertures 90 as may be required or desired by the physician.

With additional reference to FIG. 13 and reference back to FIG. 8, a pair of flexible member constructs 110A are shown coupled to proximal body 26 and securing greater trochanter 22 relative thereto and to femur 14 in accordance with the present teachings. In this configuration, the flexible member constructs 110A can be secured to apertures 90 in different positions between the first and second sides 78, 82 of proximal body 26 such that the second side 82 is not a mirror image of the first side 78. For ease of discussion, the flexible member constructs 110 in this configuration will be referred to as constructs 110A′ and 110A″. In this exemplary configuration, the loop 154 of construct 110A′ can be coupled to a third aperture 90C relative to the proximal end 86 of flanged region 74 on first side 78, as shown in FIG. 13. Flexible member construct 110A′ can extend around outer surface 318 of greater trochanter 22 and loop 154′ can be coupled to a first aperture 90A relative to proximal end 86. In this configuration, flexible member construct 110A′ can extend around greater trochanter 22 at an angle due to being positioned in first and third apertures 90A, 90C that are positioned at different distances relative to proximal end 86.

In a similar manner, flexible member construct 110A″ can be coupled to proximal body 26 such that loop 154 is coupled to a second aperture 90B on first side 78 and loop 154′ can be coupled to a fourth aperture 90D on second side 82. Flexible member construct 110A″ can extend around outer surface of greater trochanter 22 such that a portion of flexible construct 110A″ overlaps a portion of flexible construct 110A′ to provide additional retention and securement of greater trochanter 22 to proximal body 26 and femur 14, as shown in FIG. 13. In the exemplary configuration illustrated, flexible constructs 110A′ and 110A″ overlap each other in a crisscross manner to form an X-shaped pattern. It should be appreciated that while FIG. 13 illustrates use of two flexible member constructs 110A, other flexible member constructs can be used in various combinations to overlap each other in the manner discussed above.

Turning now to FIGS. 14 and 15 with reference back to FIGS. 3 and 4B, another exemplary configuration is shown for reattachment of greater trochanter 22 in accordance with the present teachings. In this configuration, proximal body 26 can include the plurality of projections or tabs 104 configured to removably receive a loop of one of flexible member constructs 110A-110D. The tabs 104 can be provided in addition to or in lieu of apertures 90. In one exemplary configuration, the tabs 104 can extend from a surface 374 inboard from a perimeter edge 378 of the first and second sides 78, 82 of the flanged regions 74, as shown in FIG. 15. It should be appreciated that while a pair of tabs 104 is shown in FIGS. 14 and 15 associated with first and second sides 78, 82, more or less tabs 104 can be provided on proximal body 26, as may be required.

In this configuration, the loops of adjustable flexible member constructs 110A-110D can be removably positioned over the tabs 104 to couple the loops to proximal body 26. In this regard, the flexible anchors 160 are not necessary for use in coupling the flexible member constructs to proximal body 26. However, it should be appreciated that the flexible member constructs 110A-110D can be used with tabs 104 while also carrying the flexible anchors 160.

In the exemplary configuration illustrated, loop 154 of flexible member construct 110A can be coupled to tab 104 on first side 78 and loop 154′ can be coupled to tab 104 on second side 82 such that flexible member construct 110A extends around outer surface 318 of greater trochanter 22, as shown in FIGS. 14 and 15. Similarly, adjustable flexible member construct 110B is shown have loops 204, 204′ on side 218 of passage portion 130 coupled to tab 104 on first side 78 and loops 204, 204′ on side 214 of passage portion 130 coupled to tab 104 on second side 82 of proximal body 26. The free ends 118, 122 of flexible member constructs 110A, 110B can be tensioned to reduce a size of the respective loops and draw greater trochanter 22 into secure engagement with proximal body 26 and femur 14 in a similar manner as discussed above. Again, it should be appreciated that other flexible member constructs can be used in addition to, in lieu of, or in combination with constructs 110A and 110B and tabs 104 of proximal body 26. It should also be appreciated that proximal body 26 with tabs 104 can be used with the various techniques and configurations discussed herein in place of apertures 90 or in combination with apertures 90 to facilitate securing greater trochanter 22 to proximal body 26 and femur 14 to promote healing.

Turning now to FIG. 16 and with reference back to FIG. 4A, another exemplary configuration is shown for reattachment of greater trochanter 22 in accordance with the present teachings. In this configuration, an attachment device can be used in connection with the through bore 106 of proximal body 26 to secure the greater trochanter 22 to femur 14 and proximal body 26. In one exemplary configuration, the attachment member can include a medial plug 382 having a head 384 with an angled bone engaging surface 386 and a body portion 390 extending therefrom. An attachment member, such as hook 394, can extend from an end of the body portion 390 opposite the head 284, as shown in FIG. 16. In one exemplary configuration, the head 384 can include a larger diameter than a diameter of through bore 106, as also shown in FIG. 16. It should be appreciated that the medial plug 382 can include various attachment members configured to receive one of the flexible member constructs 110A-110D and can be provided with or without the head 384 having the angled bone engaging surface 386.

A bore 380 can be formed through greater trochanter 22 in alignment with the through bore 106 of proximal body 26. A flexible member construct, such as construct 110B, can be coupled to the hook 394 at one end and can be secured to outer surface 318 of greater trochanter 22 at an opposite end, as shown in FIG. 16. In one exemplary configuration, the flexible construct 110B of FIG. 4A can include one of the flexible anchors 160 coupled to the summit regions 208, 208′, while the other flexible anchor 160 coupled to passage portion 130 is not required. With this construct, the passage portion 130 can be passed through bores 380 and 106 and coupled to the hook member 394. The flexible anchor 160 can be positioned relative to outer surface 318 and the free ends 118, 122 can be tensioned to secure greater trochanter 22 relative to proximal body 26 and femur 14, as also shown in FIG. 16.

It should be appreciated that bore 380 can be formed at various angles through greater trochanter 22 relative to bore 26, and that a plurality of bores 380 can be formed for receiving a corresponding plurality of flexible member constructs. In addition, it should be appreciated that the greater trochanter 22 can be secured using medial plug 382 as discussed above along with various other techniques and flexible member constructs 110A-110D, including those discussed above in connection with FIGS. 7-15.

While one or more specific examples have been described and illustrated, it will be understood by those skilled in the art that various changes may be made and equivalence may be substituted for elements thereof without departing from the scope of the present teachings as defined in the claims. Furthermore, the mixing and matching of features, elements and/or functions between various examples may be expressly contemplated herein so that one skilled in the art would appreciate from the present teachings that features, elements and/or functions of one example may be incorporated into another example as appropriate, unless described otherwise above. Moreover, many modifications may be made to adapt a particular situation or material to the present teachings without departing from the essential scope thereof. 

What is claimed is:
 1. A method for reattachment of a bone, comprising: positioning a prosthesis relative to a proximal portion of a first bone; coupling a first portion of a self-locking adjustable flexible member construct to a first attachment region of the prosthesis; positioning a second bone portion relative to the first bone proximal portion and a second bone engaging region of the prosthesis; coupling a second portion of the self-locking adjustable flexible member construct to the second bone portion; and tensioning free ends of the self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone via the self-locking adjustable flexible member construct in an absence of a knot.
 2. The method of claim 1, further comprising: forming a bore through the second bone portion that has been at least partially separated from the first bone; and wherein coupling the first portion of the self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes coupling the first portion of the self-locking adjustable flexible member construct to a plug member.
 3. The method of claim 2, wherein coupling the first portion of the self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes passing the first portion through the bore formed in the second bone portion and through a through bore in the first prosthesis, the medial plug configured to be at least partially received in the through bore of the prosthesis.
 4. The method of claim 3, wherein coupling a second portion of the self-locking adjustable flexible member construct to the second bone portion includes positioning a flexible anchor slidably coupled to the flexible member construct on an outer surface of the second bone portion adjacent the bore; and wherein tensioning free ends of the self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone includes tensioning the free ends to draw the medial plug into fixed engagement with a side of the through bore opposite a side facing the second bone.
 5. The method of claim 1, wherein the first bone includes a femur and the second bone portion includes a greater trochanter of the femur.
 6. The method of claim 1, wherein the first bone includes a humerus and the second bone portion includes a greater trochanter of the humerus.
 7. A method for reattachment of a bone, comprising: positioning a prosthesis relative to a first bone portion; coupling a first portion of a first self-locking adjustable flexible member construct to a first attachment region of the prosthesis; positioning a second bone portion relative to the first bone portion and a second bone engaging region of the prosthesis; coupling a second portion of the first self-locking adjustable flexible member construct to the second bone portion; and tensioning free ends of the first self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone via the first self-locking adjustable flexible member construct.
 8. The method of claim 7, wherein the first self-locking adjustable flexible member construct is a braided flexible suture.
 9. The method of claim 8, wherein tensioning the free ends of the first self-locking adjustable flexible member construct includes pulling on at least a first end of and a second end of the first self-locking adjustable flexible member construct that have both passed through a passage portion formed by the first self-locking adjustable flexible member construct.
 10. The method of claim 7, further comprising: forming a bore through the second bone portion that has been at least partially separated from the first bone; and wherein coupling the first portion of the first self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes coupling the first portion of the first self-locking adjustable flexible member construct to a plug member.
 11. The method of claim 10, wherein coupling the first portion of the first self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes passing the first portion through the bore formed in the second bone portion and through a through bore in the first prosthesis, the medial plug configured to be at least partially received in the through bore of the prosthesis.
 12. The method of claim 11, wherein coupling a second portion of the first self-locking adjustable flexible member construct to the second bone portion includes positioning a flexible anchor slidably coupled to the first self-locking adjustable flexible member construct on an outer surface of the second bone portion adjacent the bore; and wherein tensioning free ends of the first self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone includes tensioning the free ends to draw the medial plug into fixed engagement with a side of the through bore opposite a side facing the second bone.
 13. The method of claim 7, wherein the first bone includes a femur and the second bone portion includes a greater trochanter of the femur.
 14. The method of claim 7, further comprising: coupling a second self-locking adjustable flexible member construct to a third attachment region of the prosthesis; and positioning at least the first self-locking adjustable flexible member construct and the second self-locking adjustable flexible member construct around an outer surface of the second bone portion in an overlapping manner so as to form an X-shaped pattern with the first self-locking adjustable flexible member construct and the second self-locking adjustable flexible member construct.
 15. The method of claim 7, further comprising: positioning at least the first self-locking adjustable flexible member construct around an outer surface of the second bone portion.
 16. The method of claim 7, further comprising: forming a bore in the second bone portion; wherein coupling the first portion of the first self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes positioning a flexible anchor slidably coupled to the first self-locking adjustable flexible member adjacent an aperture define by the prosthesis; and wherein coupling a second portion of the first self-locking adjustable flexible member construct to the second bone portion includes positioning a flexible anchor slidably coupled to the first self-locking adjustable flexible member construct on an outer surface of the second bone portion adjacent a bore in the second bone portion.
 17. A method for reattachment of a bone, comprising: positioning a prosthesis relative to a first bone portion; coupling a first portion of a first self-locking adjustable flexible member construct to a first attachment region of the prosthesis; positioning a second bone portion relative to the first bone portion and a second bone engaging region of the prosthesis; coupling a second portion of the first self-locking adjustable flexible member construct to the second bone portion; and tensioning free ends of the first self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone via the first self-locking adjustable flexible member construct; wherein tensioning the free ends of the first self-locking adjustable flexible member construct includes pulling on at least a first end of and a second end of the first self-locking adjustable flexible member construct that have both passed through a passage portion formed by the first self-locking adjustable flexible member construct.
 18. The method of claim 17, further comprising: forming a bore through at least the second bone portion; wherein coupling the second portion of the first self-locking adjustable flexible member construct to the second bone portion including passing at least a portion of the second portion of the first self-locking adjustable flexible member construct through the formed bore.
 19. The method of claim 17, wherein coupling the first portion of the first self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes passing at least a portion of the first portion of the first self-locking adjustable flexible member construct through an aperture formed through the prosthesis and positioning a flexible anchor slidably coupled to the first self-locking relative to the prosthesis
 20. The method of claim 17, wherein coupling the first portion of the first self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes positioning the first portion of the first self-locking adjustable flexible member construct over at least one tab extending from the prosthesis. 